Transcription
1/25/13An Integrated Approach to TinnitusPatient ManagementPresented by:Robert W. Sweetow, Ph.D.Moderated by:Carolyn Smaka, Au.D., Editor-in-Chief, AudiologyOnlineExpert e-SeminarTECHNICAL SUPPORTNeed technical support during event?Please contact us for technical support at800-753-2160CEUsCEU Total Access members can earn continuing educationcredit for participation in this course. Be sure to take theoutcome measure following course completion to earnyour CEUs, or contact us for more information orassistance: a,SanFrancisco1
1/25/13TinnitusFacts 15%ofgeneralpopulaFon tus 80- s 10- ofmoderntheoriesofFnnitusorigin ycortex) Decreaseininhibitory(efferent)func4on Over- ‐representa4onofedge- ‐frequencies(cor4calplas4city) king- ‐ephap4ctransmission m sedaNen4onrelatedtolimbicsysteminvolvement alregions) rhistoryofmostlyconstant,high- rightmoderateandleUmoderate- ‐to- fasciculus.’ClinicalOutcomesq q gedLowryetal(2004)OtolNeurotol2
1/25/13Another“gatekeeping”theory behavior,andlong- ignalfromreachingtheauditorycortex. systemsthroughthemedialgeniculatenucleus(MGN) titshouldbepassedon. rontalcortex?TinnitusisassociatedwithabnormalEEG- itus alregions(deRidder,2011)3
vingFnnitus N 12,166;NwithFnnitus) 2,024(16%) %. hwomen. bemoreimportant. ReducFonoflikelihoodofFnnitusifnoiseisremoved 27%,ifstressisremoved 19%),ifbothremoved 42%. vidualswithmildFnnituswhoreportahighstressload.– Baigi,etal;EarandHearing2011.32,6:787- ‐789Revised habituation model(after Jastreboff and Hazell, cia4ons- ‐- ‐- eEnablerDashed lines represent neutral interpretation of tinnitus percept.ConclusionsofKochkin,etal;2011 riedbymorethan7%ofthesubjects. 4onwerehearingaids(34%)andmusic(30%). earingaidfijngprotocols. es.– eofTinnitusintheUnitedStatesandtheSelf- w.2011;18(12):10- ‐27.4
1/25/13WhyhearingaidsmayhelpFnnituspaFents lreducedinhibiFon lreorganizaFon AlterproducFonperipherallyand/orcentrally Reducecontrasttoquiet ParFallymaskFnnitus llocatedtoFnnitusfight AlloftheabovemayfacilitatehabituaFonand eofhearinglossTinnitus TherapiesooModalityAuditoryotenMaskersHearing Aids“Neuromonics”“Zen” Fractal toneso“Sound Cure”o“Co-ordinated ResetStimulation”o Cochlear ImplantsoemgagEnbicLimReduce ContrastMask Phantom PerceptSuppress HyperactivityExamplesReclassify Phantom PerceptReduce SaliencyMitigate Emotional DistressExamplesTinnitus RetrainingNeuromonicsWidex Zen TherapyAntidepressantso Cognitive-behavioral therapyo Mindfulness Based StressReductionooooAuditory- ‐Striatal- ‐LimbicConnec4vityDisrupt Information ConveyanceAvoid Interference with AuditionExamplesoooStriatal NeuromodulationVagal nerve stimulationCortical posed. nessofeach. gionofhearinglosswhileanotheraQenuatesthatregion. Canbothbecorrect,orarebothincorrect. Howcantheybothco- ‐exist?5
monicsusesaclosedsetofpre- eandencouragessoundenrichment24- ‐7.Neuromonicssuggests2- ‐4hoursperdayCogni4ve- apy auditory,a8en2on,andemo2on,andsleepdifficul2es. undtherapy(hearingaidswithaddi2onalacous2cop2ons prehensiveprogramthatintegratescogni2ve- hthecounselingandacous2ctools.6
1/25/13TinnitusandInsomnia ity55.3%foridenFfyingFnnituspaFentswithinsomnia). ,etal,2012ComponentsofIntegratedTinnitusTherapy1. ni4veandbehavioralinterven4on;2. rganiza4on;3. Acous2ctherapy(music,fractaltones,s- nedtobothrelaxandprovideacous4cs4mula4on;4. rcises.Disclosure7
1/25/13TinnitusQues4onnaire nSleepPreviousTreatmentsSubjec4veAssessmentScales TinnitusSeverityScale- ‐SweetowandLevyTinnitusHandicapInventory- ‐NewmanetalTinnitusHandicapQuesFonnaire- ‐Kuk,etalTinnitusEffectsQuesFonnaire- ‐Hallam,etalTinnitusReacFonQuesFonnaire- ‐Wilson,etalTinnitus Cognitive Questionnaire (TCQ) - Wilson and HenryTinnitus Functional Index (2012) Meikle, et es/Fnnitus- ‐clinic/Fnnitus- ‐funcFonal- ‐index.cfmWIDEX let’s talk aboutTINNITUS 23/xx8
ntakehasbeencompleted,performedinorderto: reviewthefindings, ofthe4nnitus, on, mmenda2ons.Counseling Instruc4onal Adjustment- ‐based9
1/25/13Counseling pectsoftheFnnitusitself.Forexample,itaddresses .– alnervous)system,– onsequenceofhavingahearingloss),– whatthelogicalcourseofthe4nnitusmightbe,– habituatetothe4nnitus.Habitua4on uluswithoutexer4nganyconsciouseffort. alhabitua4on ersonalfavorite .10
uli Somatosensory Auditory als4muli– iden4fies3.Theamygdaladeterminessalience11
1/25/13Adjustmentbasedcounseling ca4ons.Itisdesignedto: anxietyanddepression; iden2fyandcorrectmaladap4vethoughtsandbehaviors; lf.Cogni4vebehavioralinterven4on . ehaviors. n).Thebasicprocessesincogni4ve- ‐behavioralinterven4onare: iden4fybehaviorsandthoughtsaffectedbythe4nnitus; ntlyemployed; challengethepa4enttoiden4fynega4vethoughts; 2
1/25/13SoundtherapyconsideraFons13
1/25/13Conclusions itus(dbSL)atbaseline erfrequenciesbetween6Kand9K WhitenoiseisineffecFveasasuppressor morelikelytoyieldtotalsuppressioncomparedtoun- ‐modulatedpuretones– roll,EdwardC.Wu,EstherFine,HamidR.Djalilian,Fan- ‐GangZeng tatesignalcouldaltersynchronousresponse atewidespreadregions? atedwithrelaxaFonandstressrelief.14
sicandemoFons Slowonset,long,quietsounds–calming 72beatsperminute)- ‐relaxing RepeFFon- ‐emoFonallysaFsfying15
1/25/13Selec4ngtherightsound learned,andculturalpreferences(Iversenetal,2000). ds(thatac4vatethesympathe4cdivision) Earworms?Earworms erPsychology.The559students- ‐- ‐atanaverageageof23- ‐- tly'among61.5%ofthesample." Top10earwormlist: illRockYou"Kit- ‐Katcandy- t'saSmallWorldAUerAll" nFoncapturingmusiccanbebeneficial) tforlongtermrelief) PlayatlowlevelswheremusicblendswithFnnitus – fortheslecFonofmusicintheshort- ‐termmanagementofmildFnnitus.16
1/25/13Fractals - ‐sizecopyofthewhole, Proper4esincludeself- ‐similarityandasimpleandrecursivedefini4on ryenoughtonotbepredictable. sarebasedonin- s.SignalsaredichoFcEvidenceofeffec4veness Sweetow&Henderson- JAAA21,7,461- ‐473,2010 .2010;17(10):32- ‐42. HerzfeldandKuk,HearingReview,2011;18,(11),50- ‐55.17
1/25/13TinnitusHandicapInventorySummaryoffindings nandreducingannoyancefrom4nnitus rmuseCaveatsforinterpreFngFnnitustherapydata taFsFcsBenefit/costanalysis18
1/25/13Relaxa4onExercises ProgressiveMuscleRelaxa4on Deepbreathing Guidedimagery Sleepsugges4onsSleepsugges4ons(par4allist) Maintainastandardbed4meforeachday. Setyouralarmforthesame4meeachday. oingtosleep. Setthermostatforacomfortablebedroomtemperature. us. ughtosleep. ma4ccontributorsto4nnitus. ex. urstomach. ed.Themanual . .helpsestablishrealis4c,4me- rma4onisdemonstratedwiththeuseofcaseexamples.19
1/25/13Conclusions s4cs4muli ialneeds ksforlisteningrobert.sweetow@ucsf.edu20
1/25/13 2 Tinnitus#Facts# 15%&of&general&populaon& More&than&70%&of&hearing&impaired& individuals&have&had&Fnnitus& 80M90%&of&Fnnitus&paents&have&some&
